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Central Venous Pressure

Central venous pressure is defined as the pressure of blood in the central venous system which is essentially just prior to entry into the right atrium.

This is the point where the superior vena cava meets the inferior vena cava prior to entry into the right atrium of the heart. It is usually measured by placing a catheter in one of the veins and then threading it to this point. This procedure is usually done under aseptic techniques in a ward, operating theatre, or the intensive care unit of a well equipped and staffed hospital. A qualified medical practitioner is authorised to perform this procedure.

In normal health the amount of blood coming to the heart is balanced precisely by the amount of blood leaving the heart. The cardiovascular system will be viewed as a closed system for the purposed of this discussion. When there is blood loss or other alteration in the cardiovascular system’s homeostatic mechanism it will first be reflected in changes of the venous pressure at this point. As a rule of thumb the central venous pressure is a good indicator of the amount of blood returning to the heart from the systemic circulation. Further, it (CVP) is a good indicator of the pumping ability of the right atrium and the right ventricle. When the right atrium or ventricle is failing (e.g. following right atrial or ventricular MI) the CVP will be one of the first indicators to rise. The rising CVP indicates that the atria and/or ventricle are failing.

Diagram 1. Major blood vessels of the Heart showing blood flow.

Fluid Challenge:

Diagnoses of right ventricular failure and/or hypo volaemia are difficult without the use of invasive procedures. Sometimes, indirect means are used to evaluate hypo volaemia. The patient may be given a fluid challenge of 250 to 500 ml. This will cause the CVP to rise. CVP rise which is not sustained for more than 10 minutes suggests hypo volaemia. Serial readings are of greater use clinically because they more accurately predict the trend than single readings.

Normal CVP values.

In homeostasis CVP is from 0 to 8 cm of water. The Hospital where I work normally accepts 5 to 10 cm of water as normal. CVP is usually measured in cm of water but in some institutions it is measured in mm of mercury; when using the mercury scale 2 to 6 mm of mercury is considered normal.

Conditions which cause the CVP to rise.

Several conditions can cause the CVP to rise. Some situations which cause the CVP to rise are as follows:

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  1. tae!

  2. What does it mean?

  3. very good article. thanks a lot. it is easy to understand & follow.

  4. Hi Samantha,

    Thank You for reading and commenting. Please let me know of areas which I should improve.

    You will appreciate that these articles are for the benefit of student nurses, patients and the general public.

    Shergill.

  5. good article..its user friendly! i suggest that you have some illustrations of CVp, the materials used..the exact way how to do CVP reading! but its really helpful..tnx a lot..

  6. Dear Keith,

    Thank You for commenting on my article. I have noted your suggestions. You are a true GENTLEMAN. Yes, your suggestions for improving the article are honest and sincere. I will work on making those improvements.

    My long term goal is to help nursing students obtain suitable resources from here. I do not have a commercial interest.

  7. GOOD ARTICLE!! I JUST ASSISTED THIS KIND OF PROCEDURE IN THE MALE SURGERY WARD IN THE HOSPITAL WHERE I WORK AND THIS IS ACTUALLY MY FIRST TIME, AND THIS ARTICLE HELPED ME IN ACQUIRING SOME KNOWLEDGE ABOUT CVP.. THANKS AND HOPE TO SEE MORE SOON…. =>

  8. Good Day Richard,

    Nursing is life long learning. You have started. Keep learning. Keep helping. You will achieve alot of job satisfaction.

    If you are going through a hard time, for example when a patient dies. Take a breather, think of ways to help others more. You will lead a contented life.

  9. thanks..this article really helpful..
    now im doing my case presentation..so..thanks so much…n keep it up..u really help the student nurses like me..

  10. Hi aisyah,

    Thank You for the feedback, it is appreciated. Your comments are highly motivating to me.

    Shergill.

  11. Hello izzadin ali abead?

    Where and how are you?

  12. My relative is currentlyin the hospital with sepsis. ACVP line was inserted with a reading of 276….what does that mean, as that doesn’t seem to fall anywhere in the normal range?

  13. I came to this article in search of R heart Failure causes and values to be expected because of the failure. Yes I have some of my answer but I continue the search for pressures to be expected.

  14. Dear CT,

    There is clearly a mistake in the reading. CVP readings of 276 cms of water are not compatible with life. This pressure, if true, is more than arterial bolld pressure. This pressure is sufficient to burst human arteries. Veins are less strong than arteries.

    It is possible that the transducer is wet or is short circuiting. Please speak with the person caring for you relative and ask her to rectify the situation.

    Good Luck. Please let me know how the Nurse looking after your relative responds.

  15. if normal range of CVP is 8-10 mmH20, how can we say that there is a decrease in CVP which signifies hypovolemia if the lowest reading in the manometer starts from o?

  16. magari banzia :) )))

  17. Good Day julz,

    Different Consultants will set slightly different “norms” for a patients CVP. The zero on the manometer signifies zero just like in arterial blood pressure, normally 120/80. Zero CVP means that there is no positive or negative pressure.

    The positive pressure is generated by the blood returning to the right atrium through the superior and inferior vena Cava.

  18. The information is very precise, but I suggest to put the picture of the measuring of the CVP, because it gives more clear picture to the reader of how does it look like and how to perform it. Thank you

  19. Hi all,

    How do you read CVP when the patient is mechanically ventilated with a PEEP of 5?

  20. Good Day Michelle,

    Thank you for your question. I’m sorry fot the delay.

    Place the patient in a horizontal position. Continue to ventilate. Zero the transducer. Read the CVP. Enter the reading on the patients chart. Specify the PEEP next to the CVP reading. PEEP of 5cm. H2O is normal and usual. In extreme situations PEEPs of 15 to 20 cm. H2O may be used.

    I hope this clarifies the situation.

  21. Hi, another pointer for measuring cvp in ventilated patients…
    If they are positively pressure ventilated (simv) measure the waveform on the top part of the waveform
    as it sways with respirations, but if the patient is negatively ventilated (onlybeing assisted by the ventilator but initiating their own breaths) it is measured on the bottom of the swaying waveform. This is used within our hospital protocols.
    Great article
    Another reason a patients cvp may read over 250 is if an infusion is hooked up to it. A lot of the time the CBC canbe used for infusions which requires the nurse to temporary turn the stopcock off to the monitoring to allow the infusion to go through.
    Hope this is helpful. Great article

  22. Hi Another ICU Nurse,

    Thank You, that is another probable scenario. It is great when we nurses have a meeting of the mind. I will not forget this when I am looking after another patient.

    I want you to know that I encourage this type of debate and input. This is the most constructive and durable way of learning new things. GREAT!

  23. ur article is great!!

  24. hi there,

    thanx to u for the brief and knowledgeable article …it was very easy to understand coz u have made it so simple.

  25. I thank you for posting this article. For someone like me who does not have a clue about medical terms, I think that this really helps a lot. Thank you so much.

    I want to ask about the reading, my father is currently in the hospital and the reading on the monitor for the “CVP” is 112. What does that number actually mean?

  26. i am a graduate nurse studyg 4 boards. could u refresh me re what the different ports are used 4. thx.

  27. when CVP rises….wat will be its consequences???

  28. good article…far last preparation for OSCE FINAL MBBS EXAM…
    how to measure cvp come out in exam…huhuuhhuu..

  29. tanx for this article…perhaps i can give more efficient care to my patient having cvp…

  30. thanks! :) you can put images also :) that would help a lot. thank you!

  31. Thank for your comments. It gives me great pleasure to have been of help to students. Not long ago I was a student too.

  32. I am not in the medical field but only your name got me interested in reading the article since I am a sikh too from the Bay area. Till the end I was engrossed and found it very informative and simple to understand.

  33. so a CVP of 6, does this indicate that the client given fluids for hypovolemia is now on the verge of hypervolemia? Just trying to get the values straight and what they mean.

    Julie

  34. Hi Renu,

    I have been to the Bay Area. I have been to Las Vegas and Albuquerque. I have lived in Nevada. America is a great country but it does not look after its poor. Have you read my article about a Health Care System for the US. It can be read at:
    http://newsflavor.com/opinions/why-the-united-states-needs-a-national-health-care-plan/

    How did you guess I am a Punjabi?

    Good luck. Keep in touch.

  35. Hi Julie,

    I am sorry for not resonding in a timely manner.

    Julie, the normal range is generally between 5 and 10. So a CVP of 6 would be considered normal. Please also check with your hospital’s norm values.

    Keep in touch.

  36. Hi Nea,

    That is a very nice comment. Great. Please keep reading. Do not end the quest for more knowledge.

  37. hai.its a very good article and is very handy..if you dont mind,,i would like to ask you some questions regarding cvp..since im a final year medical student, i guess it will be useful 4 me in doing my exams well. i want to ask regarding the complications of cvp..thank you

  38. I was wondering if anyone got back to Karandeep and answered his question on the consequences of raised CVP.

  39. Hi Sofia & Karandeep,

    Consequences of raised CVP include the following. The patient will literally go into respiratory failure because the alveoli in the lungs fill up with fluid and gas exchange becomes impossible.
    I am sure you have seen patients with circulatory overload (elevated CVP). The normal intervention is to get rid of circulating fluid. This is usaully by giving them diuretics.
    If the patient has renal failure then dialysis or hemofiltration will be the treatments of choice.

    Would it help to write a full article?

  40. Hi shergill ,
    thanx for such valued sharing ,I have little bit confusion over the reading of jugular venous pressure,ie we use two scales,horizontal and vertical,moving a patient to 45 degree.
    what is the relation of horizontal scale with measurement.tnx

  41. measuring a cvp in ventilated patient with PEEP Of 5,,,follow yhe steps as what shergill said after getting the value just substract it from 5(PEEP), THEN ULL HAVE THE RESULT.

  42. Hi Ghulam Mustafa: Just out of curiosity, in which country do you live. I am in Australia now. Previously I was in Canada.

  43. thanks for this article!:) i am a student nurse currently in my 4th year and was tasked ti report on this. i am assigned to the PACU at the moment :)

  44. Hi kat,

    Thank You for your comments. Enjoy your experience in PACU. I hope you learn alot. Since it is your first assignment to PACU you may find it very thought provoking.

    Good Luck with your training and career choice. Nursing is a good field to be in.

  45. .,hi guyz!

    .,uv got a great article!!

    .,just want to know wat’s the difference of BP and CVP?

  46. lol…this site or should i say, this article is amazing…i have this assignment that must be passed by now…and there you are!..i found the answers!!!!…thanks Mr. Shergill…now i can show this to my Clinical Instructor…

    KIm of Cebu, Philippines..

  47. Good Day Kim,,

    Thank You for reading and commenting on my article. I appreciatee reader’s comments particulary when they have found my article to be useful.

    I grew up in Malaysia, not far from Cebu, Philippines. With my nursing qualifications I have travelled the world.

    Nursing is a rewarding career.

    Thank You.

  48. Hi Shergill,

    I am a newly assigned trainee in ICU.
    In my first day (Oct 1,09) my first patient is for CVP, i had the chance to see how the doctor did the procedure. But to the overwhelming experience i wasnt able to ask the doctor. i was just assisting him and my mouth cant just open out of unknown reason.

    I am so grateful about your article and you were able to answer most of the questions inside my head that time.

    Except for one: What do you call that site (vein) where the doctors usually insert the catheter for cvp?

    thanks much. and more power. I hope you continue doing this stuff. God Bless!

  49. hi shergill,
    your article is so great!!

  50. ah, this helps tremendously with my homework! im a student nurse, doing my care for the patients with neurological deficits.

    had a few patients with a CVP monitor, used concurrently with an ICPmonitoring system.

    really shed some light into the systems here. Thanks!

  51. HI Robin, Lizzy and Chakra,

    Thank You for commenting on my article It is nice to know that my article is being read and that it is helping nurses and student nurses alike. Thanks once again.

  52. central venous pressure is a procedure that measuring the pressure of superior vena cava in the right atrium of the heart. And i like this procedur.

  53. Dear Sir/Madam,

    The market has offers for CVP Manometer with 4-way stopcock and 3-way stopcock. Would anybody tell me which one is safe and better.

  54. Hi Eric,

    On which part of the manometer are the 4-way / 3-way stopcocks located?

    OR

    Are you referring to CVP lines with 3 ports / 4 ports?
    If this is your question then my answer applies.

    CVP lines with three ports are safer but if a patient needs to be given many medications then four ports is better because it offers more optimal treatment. Remember: If there are more ports more care needs to be taken during care of patient and medication administration.

    CVPs with 4 ports (lumens) are generally slightly larger. This should be a consideration too.

  55. surprisingly i am reading an article from Malaysian. =)i am one of it too.
    hai shergill,may i knw what condition cause the CVP reading to become negative
    beside the malposition of the transducer?

  56. Hi Nurse to be,

    Thank You for reading and commenting on my article.

    Saya ini Orang Malaysia dari Melacca = I am a Malaysian from Malacca. Where are you in Malaysia?

    CVP will never be below zero as long as there is fluid in the circulatory system. Low CVP readings are seen in patients with blood loss, and dehydration. I have given a commplete list in one of my ariticles.

    If you read all three articles you will know all the causes of high and low CVPs.

  57. izzit??i am in melaka too.but origanally i am from johor.
    em…ok….then why the monitor in ICU will show negative reading for CVP?

  58. maryam,saudi its been long im not exposed to hosp settings,and reading the article is easy to understand…it helps alot acquiring knowledge..expecting more gud articles..more medical practitioners will benefits.

  59. I am a first year nursing student at Monroe college in the Bronx. Your article is very informative and I am glad to know it is coming from an ICU nurse—- that is where my ambition lies.

  60. Hi nurse to be,
    a negative cvp can only happen if the measuring transducer is placed above the phlebostatic axis (area of heart that transducer is aligned to).
    This reading is a false reading and not considered accurate.
    A Cvc line is just like a large iv cannula except we can give potent drugs (eg. Inotropes etc) through it without the risk of vessel damage like we would risk by putting it through an iv in the arm. The other benefit is we can measure a patients fluid balance with it (cvp).
    The cvp only a small part of the picture when caring for critical patients. A patient who has had an Ami, we may only want to maintain a cvp of 6-10 as we do not want to risk the patient becomming overloaded from heart failure. However a patient who has just had a laparotomy will have lots of third spacing so we may want to maintain a cvp 12-18.
    A cvp is used as a trend and we need to look at the whole picture.
    Hopefully this helps
    from a clinical Nurse specialist in intensive care in Australia

  61. Hi Nurse to be,

    Matt’s answer is correct. Aligning the transducer is very important. The negative is a false negative because the procedure was flawed when the transducer was not aligned.

  62. Dear sir,

    I am Mark from India, my mother in law had a cardiac arrest and her CVP reading is around 25 to 27, what does that mean and also her BP is around 170/110. is she out of danger and her pulse rate is around 65. Her age is 71. is she out of danger ? I ma posting this question today (20/12/2010).

  63. Hi Mark – Your mother\’s CVP reading is on the higher side. If she is on a respirator then it may be normal if her PEEP is about eight or ten.

    If she is in shock then they may be deliberately keeping the CVP high. It is best to talk with the ICU doctor or a member of the treatment team for an accurate assessment of your mother-in-laws condition.

    No body above of the age of 71 is ever out of danger.

  64. Thanks Shergill,

    Thanks for your reply. Now she has been discharged.

  65. The number you saw is simply a blind erroneous reading when the cvp transducer is turned off to the patient. This value has no value.
    Forget the numbers when you are with your relative, talk to them, hold their hand, hug them . Make them ffffeelll more human and less techno PLZ

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